Key result
Bicuspid TAVR is linked to ~16% lower 1-year mortality versus tricuspid TAVR despite procedural risks.
Why the study?
Comparative outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) stenosis remain uncertain.
Does transcatheter aortic valve replacement (TAVR) improve or worsen clinical and procedural outcomes compared to TAVR in tricuspid anatomy or SAVR in adult patients with severe bicuspid aortic valve stenosis?
Meta-Analysis (n=295,615)
Does transcatheter aortic valve replacement (TAVR) improve or worsen clinical and procedural outcomes compared to TAVR in tricuspid anatomy or SAVR in adult patients with severe bicuspid aortic valve stenosis?
Relative Risk: 0.84 (95% CI 0.75–0.94)
Absolute Event Rate: 4.9% vs 7.9%
p-value: p=0.002
TAVR for bicuspid aortic stenosis carries higher early procedural risks compared to tricuspid anatomy and SAVR, but demonstrates lower 1-year mortality compared to TAV and similar early mortality compared to SAVR.
Supports selective TAVR in bicuspid stenosis despite higher procedural risks; extends meta-analyses but leaves randomized confirmation open.
BACKGROUND: Comparative outcomes of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) stenosis remain uncertain. OBJECTIVES: The authors synthesized evidence comparing: 1) TAVR outcomes in BAV vs tricuspid aortic valve (TAV) stenosis; and 2) TAVR vs surgical aortic valve replacement (SAVR) among patients with BAV stenosis. METHODS: MEDLINE, Scopus, and Cochrane CENTRAL were searched through January 31, 2026 (CRD420261304542). Random-effects models pooled risk ratios (RRs) with 95% CIs. Exploratory meta-regression assessed study-level modifiers and temporal trends in 1-year mortality. RESULTS: Fifty-two studies were included. In 39 studies comparing TAVR in BAV vs TAV, BAV was associated with higher paravalvular leak (RR: 1.44; 95% CI: 1.18-1.77; P < 0.001), aortic root injury (RR: 1.83; 95% CI: 1.10-3.04; P = 0.020), 30-day stroke (RR: 1.27; 95% CI: 1.02-1.59; P = 0.035), and 30-day mortality (RR: 1.25; 95% CI: 1.00-1.55; P = 0.047), but lower 1-year mortality (RR: 0.84; 95% CI: 0.75-0.94; P = 0.002). The Society of Thoracic Surgeons score-but not BAV anatomy-predicted 1-year mortality (RR: 1.31; 95% CI: 1.08-1.59; P = 0.006). BAV outcomes improved in recent studies (RR per year, 0.93; 95% CI: 0.87-1.00; P = 0.048). In 13 studies comparing TAVR vs SAVR in BAV, TAVR had higher paravalvular leak (RR: 7.08; 95% CI: 2.28-21.98; P < 0.001) and lower major bleeding (RR: 0.27; 95% CI: 0.17-0.44; P < 0.001) but similar 30-day stroke (P = 0.288) and mortality (P = 0.452). CONCLUSIONS: TAVR for BAV stenosis was associated with procedural risk than TAVR for TAV stenosis but lower 1-year mortality. Compared with SAVR, TAVR showed procedural trade-offs without early mortality differences.
No takes yet. Share an insight, caveat, or question.
Kumar et al. (2026) conducted a meta-analysis in Severe Bicuspid Aortic Valve Stenosis (n=295,615). Transcatheter aortic valve replacement (TAVR) vs. Tricuspid aortic valve (TAV) stenosis or Surgical aortic valve replacement (SAVR) was evaluated on 1-year mortality (TAVR in BAV vs TAV) (RR 0.84, 95% CI 0.75-0.94, p=0.002). Transcatheter aortic valve replacement for bicuspid aortic valve stenosis was associated with higher procedural risks but lower 1-year mortality (RR 0.84) compared to tricuspid aortic valve stenosis.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: